Healthcare Provider Details

I. General information

NPI: 1447524871
Provider Name (Legal Business Name): SARAH JOHNSON HEALTH EDUCATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22395 S BLACK VALLEY RD
TAHLEQUAH OK
74464-1558
US

IV. Provider business mailing address

22395 S BLACK VALLEY RD
TAHLEQUAH OK
74464-1558
US

V. Phone/Fax

Practice location:
  • Phone: 186-883-1619
  • Fax:
Mailing address:
  • Phone: 186-883-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: